As life spans lengthen, most people feel energetic long after their appearance begins to show premature signs of aging.
One of the most common requests we hear is “for the outward appearance to reflect the more youthful energy a person feels inside.” Many patients want a smoother contour and tightening of the jowl area. Some want to elevate sagging cheeks; others want to elevate facial expression “laugh lines” from their drooping position. Many want to reduce jowling in the areas of the chin and neck. Patients who request one or any combination of these improvements are seeking information about a facelift.
Rhytidectomy (rye-tidd-ec-toe-me – the technical term for facelift) can affect one’s appearance as dramatically as any facial cosmetic surgery.
Rhytidectomy is a safe, effective procedure performed to restore a more youthful appearance and less fatigued look while maintaining or improving function. Once thought a beauty procedure sought by only wealthy women, men in today’s competitive corporate workplace are increasingly seeking facelift procedures to restore a younger look that more typifies their energy level.
When patients come to our office seeking facial plastic surgery, it’s not uncommon for them to focus on a single aspect of their appearance rather than the overall picture. One of the most common concerns we hear from patients seeking facelifts is the “turkey wattle,” the loose skin dangling under the chin. Many times patients will request just a “neck lift.” It is important to know that patients are rarely satisfied with “just a neck lift.” Why? When excess neck skin is removed, the lax skin of the face bunches up in front of the ears and the look is unnatural. If a surgeon tells you he can do a neck lift alone, we strongly encourage obtaining a second opinion before proceeding. Furthermore, the benefit of doing the neck and face together is the opportunity to combine neck liposuction to obtain fat for placement elsewhere in the face. Fat injections make use of fat that would otherwise be discarded. Fat injections can be used in many areas of the face including the smile lines and for lip augmentation.
A good surgeon, knows that his responsibility is to evaluate not only the areas of concern but also the motivation behind the requests. It goes without saying, a facelift won’t save a failing marriage. Similarly some patients not ready for cosmetic surgery are better served with conservative measures, such as Botox for fine lines and wrinkles or Collagen for crows feet. Patients who educate themselves about facial rejuvenation know when and if the time is right to proceed.
When discussing rejuvenation procedures the best place to start is by looking at before and after photos to see just what can be accomplished. As you will see in the photos, patients often ask to combine a face lift with a brow lift for correction of frown lines between the eyes or blepharoplasty for improvements in bags under the eyes. Chin implants, cheek implants, rhinoplasty(nasal surgery), otoplasty (ear surgery) and lip surgery can also be performed in conjunction with a facelift.
Many patients seek information about improving superficial skin wrinkles with a chemical peel, laser surgery or similar skin resurfacing procedure. Although some improvement in facial wrinkles can be obtained from a facelift, it will not address all the superficial lines that come from premature aging, overexposure to weather and genetics. Facelifts address “saggy” skin; skin resurfacing addresses textural wrinkles and imperfections.
At your initial consultation, we will evaluate the soft tissue and bony architecture as well as the form and function of the head and neck. An overall assessment of the face provides the basis for what one may expect from a facelift. Skin type, ethnic background and age, along with the degree of deformity and function are important factors influencing the outcome of surgery.
As with all facial plastic surgery, a thorough health assessment and realistic expectations are prerequisites. Your understanding of procedures and routines is essential to a successful final result.
At your preoperative appointment our nurse will provide all the instructions for you to follow before and after surgery. On the business day prior to the operation we ask you to call to confirm your arrival time for surgery. Upon arrival for your surgery, you will talk with a nurse (who will start an IV), discuss anesthesia (local anesthesia with IV sedation keeps you asleep and comfortable) and meet with your doctor before going to the operating room. A facelift takes about three hours depending on the structure and amount of excess tissue prior to surgery. If you are having a combination of procedures your surgery will take longer. Recovery time from the anesthetic takes about an hour and you will be discharged about five to six hours from the time of admission.
When you wake up from surgery you will notice a soft, bulky head wrap dressing. Attached to your head dressing are “balls” or drains. These drains collect excess drainage and help prevent infection. Following your facelift, the nurses will ask assist you to meet the discharge criteria: to drink liquids, walk with a steady gait, void, manage your discomfort, and monitor and empty the drains. For patients who have a combination of procedures such as an eye tuck, your vision may be cloudy from the ointment we place in your eyes at the time of surgery. The nurses will review all instructions you will need for care following your facelift.
You will be asked to come to our office (not the Surgery Center) the following day after surgery for a dressing change and drain removal. Although most patients describe drain removal as discomfort rather than pain, you are encouraged to take your pain medication about an hour prior to drain removal. You will be asked to return in four to five days for suture removal.
Keep dressing dry and intact the evening after surgery. Notify your doctor if the dressings become loose or fall off. It is easy to monitor the drainage. Our nurse will show you how at the time of discharge.
Following dressing removal the morning after surgery, an elastic wrap will be applied. We will again instruct you on suture care. Cleaning the suture with a Q-tip dipped in hydrogen peroxide and then applying the antibiotic ointment twice a day is an essential part of the healing process. Sutures that have been kept lubricated with ointment are less painful to remove. Keep elastic wrap in place at all times other than suture care.
Most patients complain of discomfort more than pain. Use pain medication as directed/as needed. Do not drive or drink alcohol while taking pain medication. Taking pain medication with food helps minimize nausea sometimes associated with pain medications.
Start your antibiotic (Keflex/cephalexin) when you get home. It is not uncommon to have a low-grade fever for 24 hours following surgery.
Start swelling medication when you arrive home. Take with food.
Take Vitamin C (ascorbic acid) that helps promote healing, for two weeks following surgery.
Advance diet from liquids to soft food to your regular diet as tolerated.
Rest for entire day after surgery. Sleep with head of the bed elevated or use two to three pillows for one week after surgery. Absolutely no bending, lifting or straining. If you have little children, bend at the knees or sit on the floor and let them climb on to your lap. No driving for one week following surgery. Two weeks off work is recommended.
After 24 hours, keep incisions dry except for cleaning and ointment. Bathing is ok as long as you don’t get your incisions/hair wet. You are encouraged to shower and wash your hair twice: the evening before and morning of suture removal (usually postop day four or five).
After suture removal steristrips, which must remain dry and in place for four days are applied. Bruising can be camouflaged at one week postoperatively with make-up. Always protect your face from the sun. At this point, a hat and sunglasses are a good idea. Following surgery, our staff will tell you when it is ok to apply sunscreen, cosmetics or facial creams. Avoid unprotected prolonged sun exposure for three months following rhytidectomy to prevent pigmentation of incision lines.
Your head dressing and drains will be removed the morning after surgery. Sutures will be removed four to five days following your surgery. You will need transportation to and from these appointments. Your next appointment will be for removal of remaining clips and sutures on or around postoperative day seven. For the first ten days following surgery, please use our private side entrance (driveway entrance).
Swelling, bruising and disrupted sleep are very normal postoperative symptoms and will decrease as the healing process occurs. Assistance with daily activities the first two to three days after surgery is strongly recommended.
Following rhytidectomy, it takes time for the swelling to subside and for the skin to heal. Most patients return to work two weeks following surgery, however three weeks is ideal, depending on the degree of privacy one is trying to maintain. At three weeks postoperatively, swelling and bruising may be apparent to you but not to many of your coworkers and closest friends.
Final results following facelift are not apparent for one full year following surgery. After three months, the changes are ever so subtle, although still important. Being perfectionists about our work, you may tell us you are pleased long before the one year anniversary. However, we request that you follow-up with us at that time for postoperative photographs and so that we can enjoy your final result.